unexplained hypers

Status
Not open for further replies.
K

ky333

Active Member
Relationship to Diabetes
Parent
Just after a little help... my daughter who is 10 yrs old has, for the past few weeks had severe hypers that we cannot get down. She is fine during the night but the minute she eats she spikes and stays high all day till bedtime. Her carb ratio is now 1;4 and her correction dose 1;2. Even with this she doesnt move from >17 all day. The only thing that reduces her levels is exercise - this reduces her levels till she stops exercising and then she starts to rise again.

She is having copious amounts of norarapid - over 70 units a day. We have tested her basal and this is correct. Has anyone got any idea on what we can do? She is so fed up now she is reluctant to eat anything. This graph is today... the only dips are when she was doing PE and dancing in the gardenaaa.png
 
Could it be connected to the onset of puberty @ky333 ? It sounds very stressful. Is your daughter bolusing enough in advance of her meals? Are her injection sites ok? Could her insulin have degraded and be less effective?

I’ll tag @Sally71 as she’s a parent.
 
Have you checked her injection sites/ are you rotating these? It sounds like could be an absorption problem based on what you describe perhaps?
 
Hi. Sorry to hear your daughter is having such problems. That must be really tough, especially for a child. I am battling similar although to a lesser extent today, but I know I need another basal increase to deal with it because I have had a coupl of more sedentary days.
Which basal is she using and did you do a full 3 stage 24 hour basal test ie over several days or just test that it was holding her steady through the night?
 
Inka said:
Could it be connected to the onset of puberty @ky333 ? It sounds very stressful. Is your daughter bolusing enough in advance of her meals? Are her injection sites ok? Could her insulin have degraded and be less effective?

I’ll tag @Sally71 as she’s a parent.
Click to expand...
Thanks for reply. She now boluses over 30 min prior to each meal and we wait for a downwards arrow on dexcom. Injection sites are very varied and no lumps felt. New pods, new boxes, new insulin vials... we have honestly tried everything! Have been looking into insulin résistance.... is this possible though in someone so young?
 
Saoirse said:
Have you checked her injection sites/ are you rotating these? It sounds like could be an absorption problem based on what you describe perhaps?
Click to expand...
yes, her sites are rotated to arms, legs, stomach. All seem fine.
 
rebrascora said:
Hi. Sorry to hear your daughter is having such problems. That must be really tough, especially for a child. I am battling similar although to a lesser extent today, but I know I need another basal increase to deal with it because I have had a coupl of more sedentary days.
Which basal is she using and did you do a full 3 stage 24 hour basal test ie over several days or just test that it was holding her steady through the night?
Click to expand...
Thanks for reply. We did 3 separate basal tests, 6 hours each day for a few days. Always steady till she eats food and then levels shoot up. We can give her 5 units correction bolus and it doesnt budge. She is so fed up
 
@Saoirse Considering that pods and insulin vials are mentioned by the OP in post #5 I would guess that she is already on a pump.
 
ky333 said:
Thanks for reply. She now boluses over 30 min prior to each meal and we wait for a downwards arrow on dexcom. Injection sites are very varied and no lumps felt. New pods, new boxes, new insulin vials... we have honestly tried everything! Have been looking into insulin résistance.... is this possible though in someone so young?
Click to expand...

@ky333 I guess insulin resistance is theoretically possible in anyone but if your daughter is of normal weight, I’d think it unlikely. As she seems to be using an insulin pump, perhaps that’s part of the issue? I’ve used a pump for many years and have had a number of problems resulting in highs.

My first problem was when the whole of my stomach area basically seemed to stop working. It took me weeks to find out what it was. A change of body area and a change of cannula type caused an amazing return to normal. My second problem is that now I sometimes get sites which are fine basal-wise but in which the boluses simply don’t work properly. This sounds much more like your daughter’s problem. My team hadn’t really heard of it but it’s definitely what it is. If I didn’t eat all day my blood sugar would be fine, but the minute I bolus (through my pump) and eat, the highs start. I solved this by bolusing with a pen. I also use a pen to correct.

So, in your daughter’s case, I’d first try a change of cannula. I use three different cannula types for different body areas. However, if she has an Omnipod, I don’t think this is possible. Second, I’d try doing what I’ve described above. Leave the pump doing the basal and bolus with a pen (half unit pen for flexibility).
 
Thanks for all replies. Will certainly try every suggestion. Not sure how keen she will be to go back to injecting but at least then we will know.
This is her graph for today …. She has eaten only 8 carbs as she is so fed up. ( injected 2 units) she Is now HI and despite correction after correction nothing is helping.

1CA09AC0-8B62-4B61-869A-5670D2F3D161.png
 
Wow, that really is a shocker! Even if the pump wasn't dispensing the bolus for some reason, 8g carbs should not take her that high! It is really weird when her basal dose has been checked and is correct.
I can understand her not wanting to go back to injections but as a short term measure to see if it might be an insulin delivery/absorption issue it is worth a try. I was frustrated after just 2 days of having levels of 10-12 and multiple corrections, so I dread to think how you and your daughter must feel if this has been going on a while .... thankfully mine is now sorted after another basal increase last night. Phew!
 
Are you correcting with the pump? Don’t! Use pens. HI is obviously super-high, but I’ve had blood sugar in the 20s with pump issues. With no long-acting basal on board to mop things up a bit, it’s surprising how high you can suddenly go. Hence the increased risk of DKA with pumps.

Using a pen for boluses and corrections will, hopefully help, but it will also provide more evidence about what the issue is. Frequent highs will, in and of themselves, cause some insulin resistance, so it’s a bit of a vicious circle. Trying to break that by using pens is sensible - and recommended, at least by my pump DSN.
 
Thanks everyone. She is in school now but going to try injecting her with pens. I have rang her DSN and asked for a plan as we have been told to monitor it for the past 2 weeks. Feel we can’t go on just monitoring it. I will post again what the outcome is in case anyone is interested.
 
Yes we are definitely interested so please do update when you can, hopefully with a positive outcome soon.
It is always interesting to learn from such situations and you never know when that info might come in handy for ourselves or others.
 
we have been to see the consultant. He feels she may be starting puberty slightly earlier than most which is causing her insulin resistance. He has doubled all her basal rates and changed her insulin over to Fiasp. Fingers crossed. Now need to research fiasp and how to dose for this. He said its just a straight swap but can only imagine what would happen if I gave her 16units as a bolus on fiasp! ( she is currently on 1:4 ratio)
 
I use Fiasp after originally being on NovoRapid and after nearly 3 months I gave up on it and went back to NR because I was so frustrated with it. The next time I tired it I promised myself I would stick at it for a whole year and just after another 3 months of frustration I seemed to make a breakthrough. I find I need to be "braver" with Fiasp. For me I found it doesn't like high levels and basically turns almost to water once I get above 10 and I end up having to stack corrections to get my levels back down once I am into double figures. As a result I try to get corrections in as soon as I see my levels at 8 and rising so I have to be much more proactive. However, if I do exercise with Fiasp on board I am much more sensitive to it and it drops me like a stone. I don't find it much quicker than NR. I need 45mins prebolus time at breakfast (75mins with NR) and 15-20 mins at other times of day (20-25 with NR). If my levels are above 10 before meals I can sometimes be waiting 2 hours to eat because it takes forever to come down and I try not to eat when my levels are above 6 otherwise I am straight back up into double figures and battling again. If my levels are in the 4s it usually works a bit quicker. These are just quirks I have found and I am certainly not recommending anyone prebolus 45 mins without carefully testing and extending their prebolus time and I am not advocating people stack insulin corrections, but this is what I needed to do to make it work for me. I find that I use more Fiasp than I did NR because corrections need a bigger overall dose. I hope you have a more positive experience with it. I have stuck with it because I have found a way to make it work and it is marginally better than NR and I don't want the aggravation of having to readjust to NR again, but I don't love it like I do my Levemir.
Good luck with it. I will be interested to see how you find it.
 
ky333 said:
we have been to see the consultant. He feels she may be starting puberty slightly earlier than most which is causing her insulin resistance. He has doubled all her basal rates and changed her insulin over to Fiasp. Fingers crossed. Now need to research fiasp and how to dose for this. He said its just a straight swap but can only imagine what would happen if I gave her 16units as a bolus on fiasp! ( she is currently on 1:4 ratio)
Click to expand...

Seems possible, as I said above. Hormones can cause surprisingly big changes. Would doubling all her basal rates not cause her to go low at night (you said she was ok at night)? Remember you don’t have to accept the Fiasp if you’re uneasy about it.
 
ky333 said:
we have been to see the consultant. He feels she may be starting puberty slightly earlier than most which is causing her insulin resistance. He has doubled all her basal rates and changed her insulin over to Fiasp. Fingers crossed. Now need to research fiasp and how to dose for this. He said its just a straight swap but can only imagine what would happen if I gave her 16units as a bolus on fiasp! ( she is currently on 1:4 ratio)
Click to expand...

There's charts available online, you will see that it has faster onset & reaches its peak earlier than novorapid.

Been on fiasp while now having used novorapid previously, own experience matches with what manufacturer says but still prebolus. Bolus doses stayed same for me between both insulins, all would say is if doing straight swap be careful for few days until you know how insulin works for daughter, if in doubt seek advice
 
Oh bless her. Puberty can cause insulin resistance so is the likely reason. I hope the fiasp helps. Do lean on your team to troubleshoot doses and to try different things if they don’t work. We were using a tslim and dexcom at this phase at a similar age so managed pretty well because we could increase the background rate during the day. Once periods had started we then dealt with the major fluctuations in mood (which massively impacted diabetes management) with the pill and whilst insulin needs are still a lot higher than before it’s all much more predictable. (I have a trans boy so whilst I refer to him with male pronouns he’s going through an oestrogen dominant puberty).

One thing our team suggested is that high bolus amounts are sometimes harder for the body to deal with so we would split doses over 20 units on the pump. He’s back on injections now and less keen to split the bolus so we just manage the best we can. I don’t know what’s possible with the set up you have but if you can split the dose that may help.
 
Status
Not open for further replies.
Back
Top